PACs: Benign Bystanders or AF in Disguise? | JACC Baran

Premature atrial complexes (PACs) are among the most common arrhythmias encountered in daily practice and are often dismissed as benign. But are they truly harmless—or could some represent the earliest stage of atrial fibrillation (AF)? Hosts Mitsuaki Sawano, MD, and Hiroyuki Sato, MD welcome Satoshi Higuchi, MD (Tokyo Women's Medical University) to discuss his JACC: Clinical Electrophysiology study, Atrial Effective Refractory Periods in Patients With Frequent Premature Atrial Complexes: Implications for Atrial Fibrillation. Building on translational work from experimental models, the study compares atrial effective refractory periods (AERP) in patients with frequent PACs, paroxysmal AF, and persistent AF to better define the electrophysiologic substrate underlying these conditions. The episode explores how electrical remodeling differs between PACs and AF, why pulmonary vein AERP shortens before more diffuse atrial remodeling develops, and what these findings reveal about the progression from atrial ectopy to sustained arrhythmia. The discussion also examines the emerging concept of PAC-induced atrial cardiomyopathy, the challenge of distinguishing "benign" from potentially malignant PACs, and the future of risk stratification and preventive intervention before AF becomes established.

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Episoder(82)

The Lancet: OPTIMA-AF, Is 1 Month Enough After PCI? | JACC Baran

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, welcome Yohei Sotomi, MD, PhD (The University of Osaka), and Ken Kozuma, MD, PhD (Teikyo University) for a spe...

25 Aug 47min

HFpEF: Why Earlier May Be Better | JACC Baran

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Shunichi Doi, MD (St. Marianna University School of Medicine) to discuss his JACC: Heart Failure study, Heart Failure Dur...

18 Aug 38min

Post-PCI Hematoma: What IVUS Tells Us | JACC Baran

Percutaneous coronary intervention (PCI) is safer than ever, yet coronary hematoma remains an underrecognized cause of early ischemic complications. In this episode, Host Mitsuaki Sawano, MD welcome T...

11 Aug 35min

Pediatric Heart Transplantation: When Priority Doesn't Match Urgency | JACC Baran

Pediatric heart transplantation is one of medicine's scarcest resources, where every allocation decision can mean the difference between life and death. But does the current system truly prioritize th...

4 Aug 35min

Cancer VTE + DOAC: Who Will Bleed? | JACC Baran

Patients with active cancer face a difficult balance: preventing recurrent venous thromboembolism while avoiding major bleeding during anticoagulation. But which patients are truly at highest bleeding...

21 Jul 39min

HFpEF Without Obesity: What Coronary Microcirculation Tells Us | JACC Baran

Host Mitsuaki Sawano, MD, welcomes Kai Nogami, MD (Mayo Clinic), to discuss his JACC Brief Report, "Higher Prevalence of Coronary Microvascular Dysfunction in Patients With HFpEF Without Obesity." Why...

14 Jul 37min

What Autopsy Reveals About MINOCA and Sudden Cardiac Death | JACC Baran

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, Hiroyuki Sato, MD, and Shun Kosaka, MD welcome Dr. Kosuke Nakasuka, MD, PhD to discuss his JACC study, Sudden Cardiac Death Due to Myocardial Infarction W...

7 Jul 45min